Predictive value of combined systemic immunoinflammatory index and prognostic nutritional index on the prognosis of patients with hepatocellular carcinoma after radical resection

doi:10.3877/cma.j.issn.1674-0793.2023.02.002

Abstract

Abstract:

Objective

To explore the prognostic value of combined systemic immune inflammatory index (SII) and prognostic nutritional index (PNI) in patients with hepatocellular carcinoma (HCC) undergoing radical resection.

Methods

From October 2016 to September 2017, the clinicopathological data and follow-up information of 144 patients who underwent HCC radical resection in the First Affiliated Hospital of Bengbu Medical College were collected. The receiver operator characteristics (ROC) curve was used to calculate the cut-off values of SII and PNI, and the patients were divided into high SII group, low SII group, high PNI group, and low PNI group. The relationship between different SII and PNI groups and clinical pathological data were analyzed, and the factors related to the prognosis of patients were analyzed by univariate and Cox multivariate regression models. According to the expression level of SII and PNI, patients were divided into low SII+high PNI group, high SII+low PNI group, and patients with high SII+high PNI or low SII+low PNI were included in the other group. Kaplan-Meier curve was used to analyze the 1-, 3-, and 5-year survival after surgery, and ROC curves were used to evaluate the predictive efficacy of SII, PNI, and SII+PNI on the prognosis of patients after surgery.

Results

The area under curve (AUC) of SII was 0.778, and the corresponding cut-off value was 301.48. The AUC of PNI was 0.721, and the corresponding truncation value was 47.60. SII was correlated with cirrhosis, AFP level, TNM staging and tumor diameter (P<0.05), and PNI was correlated with age, AFP level, TNM staging and tumor diameter (P<0.05). Multivariate analysis showed that HBsAg, AFP level, TNM staging, SII and PNI were related to the prognosis. The 1-, 3- and 5-year survival rates of patients in the low SII group and high PNI group were better than those in the high SII group and low PNI group respectively (all P<0.05). Compared with patients with high SII+low PNI, high SII+high PNI and low SII+low PNI, the patients with low SII+high PNI had higher survival rate (P<0.05). ROC curve showed that AUC of SII+PNI was 0.840, higher than SII and PNI.

Conclusion

Both SII and PNI can predict the prognosis of HCC patients after curative resection, and the combination of SII and PNI can obtain more accurate prediction results than any single index.

Key words: Hepatocellular carcinoma, Systemic immunoinflammatory index, Prognostic nutritional index, Prognosis

Hongxiang Yin, Jiakang Duan, Bowen Jiang, Yi Tan. Predictive value of combined systemic immunoinflammatory index and prognostic nutritional index on the prognosis of patients with hepatocellular carcinoma after radical resection[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 93-98.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2023.02.002

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References 17

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临床病理特征	低SII组	高SII组	χ²值	P值	低PNI组	高PNI组	χ²值	P值
例数	59	85			97	47
年龄(岁)			0.359	0.549			25.326	<0.001^a
<60	43	58			64	10
≥60	16	27			33	37
性别(男/女)			0.083	0.774			0.489	0.484
男	49	69			81	37
女	10	16			16	10
HbsAg			0.783	0.376			1.579	0.209
阴性	10	10			13	3
阳性	49	75			84	44
肝硬化			8.031	0.005^a			0.017	0.895
无	31	64			63	30
有	28	21			34	17
AFP(μg/L)			4.364	0.037^a			6.099	0.014^a
<200	39	54			58	35
≥200	20	31			39	12
Child-Pugh分级			0.105	0.746			0.156	0.693
A	55	78			89	44
B	4	7			8	3
局部侵犯			1.737	0.187			0.063	0.803
无	43	53			66	31
有	16	32			31	16
淋巴结转移			0.468	0.485			0.376	0.473
无	2	3			4	1
有	57	82			93	46
TNM分期			8.539	0.014^a			18.198	<0.001^a
Ⅰ~Ⅱ	52	60			71	40
Ⅲ	7	25			26	7
肿瘤数目(个)			0.397	0.528			0.923	0.337
<2	49	67			76	40
≥2	10	18			21	7
肿瘤直径(cm)			4.419	0.042^a			9.206	0.014^a
<5	14	34			32	28
≥5	45	51			65	19

临床病理特征	低SII组	高SII组	χ²值	P值	低PNI组	高PNI组	χ²值	P值
例数	59	85			97	47
年龄(岁)			0.359	0.549			25.326	<0.001^a
<60	43	58			64	10
≥60	16	27			33	37
性别(男/女)			0.083	0.774			0.489	0.484
男	49	69			81	37
女	10	16			16	10
HbsAg			0.783	0.376			1.579	0.209
阴性	10	10			13	3
阳性	49	75			84	44
肝硬化			8.031	0.005^a			0.017	0.895
无	31	64			63	30
有	28	21			34	17
AFP(μg/L)			4.364	0.037^a			6.099	0.014^a
<200	39	54			58	35
≥200	20	31			39	12
Child-Pugh分级			0.105	0.746			0.156	0.693
A	55	78			89	44
B	4	7			8	3
局部侵犯			1.737	0.187			0.063	0.803
无	43	53			66	31
有	16	32			31	16
淋巴结转移			0.468	0.485			0.376	0.473
无	2	3			4	1
有	57	82			93	46
TNM分期			8.539	0.014^a			18.198	<0.001^a
Ⅰ~Ⅱ	52	60			71	40
Ⅲ	7	25			26	7
肿瘤数目(个)			0.397	0.528			0.923	0.337
<2	49	67			76	40
≥2	10	18			21	7
肿瘤直径(cm)			4.419	0.042^a			9.206	0.014^a
<5	14	34			32	28
≥5	45	51			65	19

临床病理特征	单因素分析				多因素分析
临床病理特征	SE	HR	95% CI	P值	β	SE	Wald	HR	95% CI	P值
年龄(岁, <60/≥60)	0.240	1.620	1.012~2.592	0.044	-0.450	0.266	2.866	0.637	0.378~1.074	0.090
性别(男/女)	0.297	1.178	0.658~2.108	0.581	-	-	-		-	-
HBsAg(-/+)	0.271	1.947	1.217~3.115	0.005	0.765	0.270	8.045	2.150	1.267~3.648	0.005^a
肝硬化(无/有)	0.251	1.126	0.688~1.843	0.638	-	-	-		-	-
AFP(μg/L, <200/≥200)	0.233	0.573	0.363~0.906	0.037	-0.642	0.244	6.940	0.526	0.327~0.849	0.008^a
局部侵犯(无/有)	0.256	0.849	0.528~1.365	0.499	-	-	-		-	-
淋巴结转移(无/有)	0.518	0.319	0.116~0.881	0.027	-0.247	0.560	0.195	0.781	0.260~2.342	0.695
TNM分期(Ⅰ~Ⅱ/Ⅲ)	0.315	0.498	0.268~0.604	0.017	-0.605	0.283	4.567	0.546	0.313~0.951	-0.032^a
肿瘤数目(个, <2/≥2)	0.271	0.696	0.409~1.184	0.181	-	-	-		-	-
肿瘤直径(cm, < 5/≥5)	0.024	1.135	1.083~1.188	<0.001	0.056	0.031	3.325	1.058	0.996~1.123	0.068
SII	0.236	0.419	0.264~0.666	<0.001	-1.029	2.720	13.212	0.357	0.205~0.622	<0.001^a
PNI	0.242	1.635	1.018~2.626	0.042	0.642	0.364	5.886	1.900	1.131~3.190	0.015^a

临床病理特征	单因素分析				多因素分析
临床病理特征	SE	HR	95% CI	P值	β	SE	Wald	HR	95% CI	P值
年龄(岁, <60/≥60)	0.240	1.620	1.012~2.592	0.044	-0.450	0.266	2.866	0.637	0.378~1.074	0.090
性别(男/女)	0.297	1.178	0.658~2.108	0.581	-	-	-		-	-
HBsAg(-/+)	0.271	1.947	1.217~3.115	0.005	0.765	0.270	8.045	2.150	1.267~3.648	0.005^a
肝硬化(无/有)	0.251	1.126	0.688~1.843	0.638	-	-	-		-	-
AFP(μg/L, <200/≥200)	0.233	0.573	0.363~0.906	0.037	-0.642	0.244	6.940	0.526	0.327~0.849	0.008^a
局部侵犯(无/有)	0.256	0.849	0.528~1.365	0.499	-	-	-		-	-
淋巴结转移(无/有)	0.518	0.319	0.116~0.881	0.027	-0.247	0.560	0.195	0.781	0.260~2.342	0.695
TNM分期(Ⅰ~Ⅱ/Ⅲ)	0.315	0.498	0.268~0.604	0.017	-0.605	0.283	4.567	0.546	0.313~0.951	-0.032^a
肿瘤数目(个, <2/≥2)	0.271	0.696	0.409~1.184	0.181	-	-	-		-	-
肿瘤直径(cm, < 5/≥5)	0.024	1.135	1.083~1.188	<0.001	0.056	0.031	3.325	1.058	0.996~1.123	0.068
SII	0.236	0.419	0.264~0.666	<0.001	-1.029	2.720	13.212	0.357	0.205~0.622	<0.001^a
PNI	0.242	1.635	1.018~2.626	0.042	0.642	0.364	5.886	1.900	1.131~3.190	0.015^a

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